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I was an advocate for “person-centered care,” long before it became part of elder care terminology. “Person centered care” simply means that a community, or another entity, adapts and delivers care or amenities according to the habits of the senior. As the former Admissions Director of a community that catered to residents at the independent, assisted, and intermediate nursing home level, I knew that flexibility was the key to keeping the place full. Most importantly, it kept the residents happy.

The organization that I represented had not changed much aesthetically or administratively since it was built in the early 1950’s. Consequently, I broke just about every rule in the book (often to the dismay of the religious order that had once reigned there in the past) in order to keep the place filled. At one point, I admitted a cheerful, boisterous, resident who asked me if he could bring his extremely loud, talkative, Cockatiel to live with him when he moved in. I said, “of course,” even though the community had a strict no pets policy. The bird absolutely delighted the residents and I often saw a group of them congregating in the owner’s room before dinner. Another resident’s daughter told me that her Father was a sports fanatic and that he often watched as many as six different events at the same time. Bear in mind, we are talking about events that occurred 15 years ago, and the building was not yet cable friendly. I said, “That’s no problem, we’ll just install a satellite dish outside his window.” You can imagine how many eyebrows I raised when the satellite dish company pulled up and started to hammer away.There was also a long-term resident who confided to me that she had an illness that would eventually cause her to need a feeding tube. She said that above all, she wanted to live out her final days at the community rather than be moved to a nursing home where they could accommodate her needs. I was very touched by her request. I approached the Administrator and asked if there was something we could do for her. He was able to petition the State on a one time basis to allow the feeding tube, and her request was granted! Thankfully, times have changed since then. As a senior living advisor, I have learned that some but not all of the nursing homes are delivering “person-centered care.”

Real Life Story

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A recent article published in the Chicago Tribune entitled “Refund sought; ‘every little dime would help’ emphasizes two important points. First, the media has provided only the complainer’s side of the story. There are so many facts about this case we don’t know. Second, it points out the true pitfalls of having a neighbor of 47 years, and someone who is inexperienced at navigating the long term care health system calling the shots for an elderly person. As a senior living advisor who acts as Power Of Attorney for several of my clients, I cannot express the importance of having an experienced individual take on this serious task.

According to the article, the elderly person had fallen and spent over three months in a rehabilitation facility beginning in November. If the elderly person spent over 100 days in rehabilitation after a three night hospital stay, it is likely she had exhausted her Medicare benefit period. The costs to remain at the same rehabilitation community as a private pay client would have been prohibitive. I have in many cases, seen clients released to a lower level of care (before they are ready) in an effort to avoid paying higher costs. The Supportive Living community mentioned in this case provides only stand by assistance with bathing, dressing, transferring, toileting, walking and eating. There is no nurse present on a 24 hour basis. After living at the Supportive Living community for six weeks, the resident was sent back to a skilled nursing community after developing an infection in her heel. According to Doctors, the source of the infection was unknown and treated with an IV, which is a type of care Supportive Living communities are not licensed to deliver. After the diagnosis of infection, the resident was placed back in a skilled nursing home (which is the same level of care she was receiving during rehabilitation). I wouldn’t have allowed my client to make that sort of transition unless they were really ready.

The article also documents that the elderly woman’s Power Of Attorney tried to obtain a refund of a $2,500 move in fee. As a senior living advisor, I am unaware of very few move in fees that are refundable. Off hand, I can think of only one community that offers a refundable move in fee. But, that is one item that you need to be clear on before you move a loved one into a community. This Power Of Attorney insisted that the money be returned because the resident was only there six weeks. Needless to say, she still moved in.

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I recently had a situation occur that I’d like to share, lest the same circumstances arise for you.

My client’s were a family whose Mother was living in an independent living retirement community with a full-time caregiver. Her health issues had escalated to the point where she could no longer perform any activities of daily living on her own. She was approaching the point where she was a two-person assist. The cost of two full time caregivers plus the independent living rent was prohibitive. Therefore, the family retained me as a senior living advisor and certified care manager to find a nursing home for her.

I actually anticipated that the placement was going to be fairly easy. They wanted a private room for their Mom, with specific location parameters, and a certain religious affiliation if possible. Sounds easy, right?

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I just turned 55 on my last birthday. Although some people consider 55 as the official age of becoming a senior, I have never allowed my age to deter me from participating in my hobby of tap and jazz dancing. As a senior living advisor, (and a former, part-time children’s dance teacher of 13 years, hobby only) I am also pleased to see so many of the senior communities offering dance therapy classes to their residents. I have also taught tap and ballet on a voluntary basis in some of the assisted living communities that specialize in dementia care and several senior centers. I was made aware that several of the participants also had Parkinson’s disease.

Exercise that is performed several times a week can help to elevate a person’s immune system and make them feel better about themselves. That is because of the endorphins that are released. The exercise classes provide camaraderie while encouraging seniors to move all of their body parts. If a person moves their limbs, it increases hand to eye coordination, strengthens the core, and helps balance.

I approached the classes as I would have at any other basic level. I included combinations and repetition to Frank Sinatra and Bobby Darin songs. I found that most of my “students,” found ease in doing the tap warm ups, grape vines, and some jazz movements, even if they were confined to a wheel chair. Many of the participants said that their joints felt better, their overall movement improved, and most importantly their spirits had been lifted. After the class had finished, I always served them a snack and we’d talk for a while. Some of the residents with dementia would reminisce about where they used to go to dance with their spouses. One resident in particular spoke about a church in Evanston, Illinois that had a Scottish affiliation and offered Scottish dance lessons. She even went so far as to quote me the exact street address.The repetition of certain exercises helps people with Parkinson’s to concentrate on movements that have become difficult for them, such as doing two things at once. People who have suffered a stroke are able to express themselves by moving to the music even though they can’t talk. Sometimes peoples’ medications stop working for them and the classes give them relief from their symptoms.

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Adult day can care be a very cost effective option to both senior housing placement and non-medical home care. It is an excellent alternative for the working children of seniors who aren’t ready to have the senior move to a long term care community.

Adult Day Care provides structured activities to seniors who have physical and cognitive impairments. But, each program is designed differently with regard to hours of operation, and if a medical or social model is offered. The medical model helps the senior remain as independent as possible while providing care to assist the person with their activities of daily living such as eating, toileting, taking medication, bathing (at some sites), dressing (if need be), and walking. The medical model is usually overseen by a nurse. The social model may be an option for people who are able to live alone with some help but may need socialization during the day. The social model doesn’t provide the “hands on” assistance provided in the medical model. The seniors really need to be more independent and toilet on their own. Adult Day Care may postpone a senior from being placed in a long term care community.

Adult Day Care Centers will usually have a nurse or social worker evaluate the senior before they enter a program to see if his/her needs can be met. Some seniors need more assistance than is provided. Therefore, the medical model is more appropriate for him/her.

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A recent, nationally publicized tragedy involving a woman with memory issues emphasizes the fact that a senior with dementia (even in the early stages) should never travel alone. The woman’s family was aware of the fact that she was having memory issues. Yet, they allowed her to fly from Barbados to Washington alone (flight time approximately four and one half hours) with a layover in Miami. The article states that the family was concerned about her memory issues and planned to have her checked once she arrived back in Washington. It seems to me that she should have been checked prior to doing any travelling. In addition, the woman had poor vision. She walked past an airline agent who was carrying an electronic sign with her name on it. He was to escort her to the baggage area where the daughter was waiting. Her physician would have advised against her travelling alone and the tragedy could have been prevented.

As a senior living advisor, I always tell my clients that a senior with dementia should never travel alone. Here are some other tips that I offer to ease the stress of travelling with a senior who has dementia:

:-Always stay with the person in the airport. Do not turn your back on him/her.

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One of the facts that I stress to my clients is that skilled nursing is not one-to-one care. Other facts that a lot of my clients don’t take into account are how the costs of a 24 hour caregiver (which can start at $200 per day if they agency is licensed) are going to affect their loved ones’ long term financial picture. This usually occurs when the child is in a rush and s/he doesn’t have the time to research all of the options. Or, the child feels guilty about the stigma associated with placement in a long-term care community. Everyone’s circumstances are different. As a Certified Care Manager, I assist my clients with looking at all of the options, including staying at home. But, you have to keep the senior’s long term financial picture in mind. If a senior can afford to stay at home, that is the best place for him/her if their medical conditions don’t require the presence of a nurse and if the socialization with the caregiver is adequate. People hire me for my senior living advisor services once they have already hired the full-time caregiver and discover after a period of time that the loved one is running out of money.

Last November, a family hired me because their Mother had three, unlicensed caregivers who were taking care of her in shifts for the past ten years. The son told me she had easily spent over one million dollars on caregivers. When he and his siblings realized that she was going to run out of liquid cash in the next year, they hired me to find a nursing home for her.

When I arrived at her home, the place was spotless. My client was impeccably clean and every single hair on her head was in place. She was sitting in a cheerful kitchen where the caregiver had fed her breakfast. Although my client was a total assist with all activities of daily living including toileting, and had latter stage dementia, I saw her smile and try to respond to the caregiver’s kind tone of voice. It was obvious that my client had received excellent care. That observation was verified by her son, who informed me that he often stopped in on all three ladies unannounced.

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During the past several months, I have been hired to find senior living options for many clients who have been diagnosed with depression. Some of them have been at the independent living level of care. I was fortunate to sit down with several of my clients and find out what it is like to have the disease. I must admit that I have a new sympathy for anyone with the diagnosis.

Depression is a disease that is characterized by feelings of sadness and at times uselessness that affect an individual’s ability to function. The causes aren’t known, but some of the things that are thought to to cause it are changes in the brain, family history, environment, and life’s experiences. For example, senior’s become very depressed after the loss of a spouse. During the holidays, the depression often intensifies as the senior further contemplates the loss of a loved one.

My clients have shared that they often feel tired, restless, irritable, worthless, and have trouble sleeping. On the other hand, they may sleep too much or overeat. They also experience symptoms like a stomach ache that won’t go away, excessive crying, strange thoughts and thoughts of suicide. No one’s symptoms are ever the same. The depression can also be masked by other illnesses for which the senior has already been diagnosed and is taking medications.

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I read the attached article, “Adult Children Ignoring Confucius Risk Lawsuits in China,” about the elderly having the option of suing their children if they don’t visit them enough while they are in a long term care community. I used to be the Marketing/Admissions Director of a large Continuing Care Retirement Community where I dealt with admitting seniors who were at the independent, assisted, or nursing home levels of care. The article made me reminisce about acting as, “manager of the weekend,” and some of the experiences I had with family members who were regular visitors. In other words, the families were the polar opposites of the “no shows” referred to in this article.

As manager of the weekend, each staff member at the community had to take a turn at watching over the place. This meant taking care of the needs of the residents, as well as meeting and greeting the family members who came to visit on the weekends. The manager was instructed to walk the hallways to observe cleanliness and anything that seemed out of the ordinary. Another assignment was to circulate in the dining rooms during meal times, ask the residents about the acceptability of the food, and to eat the food to make our own assessment. The best part of acting as the “manager of the weekend” was that I got to see all of the visiting family members that I had previously been involved with during the admissions process. However, I chuckled at the content of this article because some of the families didn’t deserve to be penalized because they didn’t visit enough. They deserved to be scolded for what they did while they were they visiting loved ones, particularly the seniors who were at the independent level. Let me share some of the events with you.

There was a woman who had lived at the community for a number of years and was practically a model resident. She never had a single hair out of place and was always dressed in the latest fashions with a hand bag to match. She had a son who lived in the neighborhood. He visited her each weekend without fail. One time I noticed a large bottle of liquor in her room. Residents at the independent level were allowed to keep liquor. Since independent living is just like an apartment building, there were no rules against it. I was told by another staff member that she kept it to offer her son a cocktail when he visited. The problem was that while I was walking the hallways after the son had left, I found her wandering the hallways half looped on several occasions. I had to escort her to the dining room to make sure that she ate. The same thing happened with another resident whose girlfriend picked him up on Saturdays to take him out for dinner.

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I am often confronted with some interesting family dynamics when a family hires me to consult with them. At times, the children are willing to accept my advice without reservation. Sometimes, there is often one child who wants to prove that s/he can “do this on her/his own.” While there is usually one child who emerges as the spokesperson for the family, the choice of the right care should be the result of a family consensus and not the persuasive skills of a ringleader. Consensus should be coupled with careful comparison of cost and methods of payment, level of care needed, staffing considerations, location, and quality of care involved with all the senior living options. Please read the following “Real Life Story,” that exemplifies my point

Real Life Story

One of my clients who did not follow my initial advice contacted me last week. She was unhappy with the care that her Mother was receiving at an assisted living community that specializes in memory support.

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